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Esophageal Cancer Research and Treatment / Gastrointestinal Tumor Research and Treatment / Gastric Cancer Management and Outcomes · Journal article
Journal of Surgical Oncology · August 16, 2026
Well-designed and adequately powered for the question it asks.
This national registry cohort study of 3,676 patients with cT2N0 gastric adenocarcinoma reports that both perioperative and adjuvant chemotherapy reduce mortality compared to surgery alone, but adjuvant chemotherapy showed 21% superior mortality reduction versus perioperative chemotherapy. The finding suggests upfront surgical resection followed by adjuvant therapy may be the preferred sequencing, though the observational design cannot definitively establish causation.
Retrospective cohort study. Patients with clinical T2N0 gastric adenocarcinoma who underwent surgical resection.. Intervention: Perioperative chemotherapy or adjuvant chemotherapy plus surgery. Compared with: Surgery alone or perioperative chemotherapy versus adjuvant chemotherapy. n = 3,676.
61.3% of 3,676 patients received no chemotherapy; 19.4% received perioperative chemotherapy; 19.2% received adjuvant chemotherapy Perioperative chemotherapy associated with HR 0.64 (p < 0.001) and adjuvant chemotherapy with HR 0.68 (p < 0.001) versus no chemotherapy Adjuvant chemotherapy showed 21% decrease in mortality compared to perioperative chemotherapy (HR 0.79, p = 0.015)
Adjuvant chemotherapy showed 21% decrease in mortality compared to perioperative chemotherapy (HR 0.79, p = 0.015)
Clinicians should consider adjuvant chemotherapy over perioperative chemotherapy for cT2N0 gastric cancer, as observational data suggest superior survival outcomes with the adjuvant approach. However, prospective randomized evidence directly comparing these sequences in this stage would be needed to confirm causation and guide definitive practice change.
Large, well-powered observational cohort study from a national database demonstrating superior survival with adjuvant versus perioperative chemotherapy in cT2N0 gastric cancer, with multivariable analysis and clear effect sizes, though observational design limits causal inference.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should consider adjuvant chemotherapy over perioperative chemotherapy for cT2N0 gastric cancer, as observational data suggest superior survival outcomes with the adjuvant approach. However, prospective randomized evidence directly comparing these sequences in this stage would be needed to confirm causation and guide definitive practice change.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
INTRODUCTION: Randomized controlled trials have demonstrated substantial benefit of perioperative chemotherapy (PC) and surgery for locally advanced gastric adenocarcinoma. Patients with clinical T2N0 (cT2N0) gastric adenocarcinoma were included in these trials, but the benefit of PC remains unclear in this intermediate-stage disease due to the small number of patients included. The goal of this study was to determine the role and sequencing of chemotherapy for resected cT2N0 gastric adenocarcinoma. METHODS: The National Cancer Database from 2004 to 2020 was used to identify patients with cT2N0 gastric adenocarcinoma who underwent surgical resection. Patients were stratified by receipt of chemotherapy into three groups: (1) no chemotherapy, (2) perioperative chemotherapy (PC), and (3) adjuvant chemotherapy (AT). The primary outcome was overall survival. RESULTS: Of 3676 patients with cT2N0 gastric adenocarcinoma, 61.3% received no chemotherapy, 19.4% received PC, and 19.2% received AT. Of the 2961 patients who underwent upfront surgical resection, 28.8% (854) were upstaged on final pathology. Multivariable survival analysis revealed that both PC and AT were associated with a decreased mortality compared to no chemotherapy (0.64 and 0.68, respectively, p < 0.001). AT was associated with a 21% decrease in mortality compared to PC (HR 0.79, p = 0.015). CONCLUSION: Patients presenting with cT2N0 gastric adenocarcinoma benefit from chemotherapy in addition to surgery, although a minority of patients received guideline concordant care. Patients who received adjuvant chemotherapy had superior outcomes compared to those who received perioperative chemotherapy. The optimal treatment for cT2N0 gastric cancer should include surgery and chemotherapy, and consideration should be given to a strategy of upfront surgical resection and adjuvant therapy rather than perioperative chemotherapy.
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